case report SequentialResponse of a Platinum-Sensitive Ovarian Cancer Recurrence to Olaparib after Previous Response to Niraparib -A Case Report
Edgar Petru
Department of Obstetrics and Gynecology, Medical University of Graz, Austria
*Corresponding author: Edgar Petru, Department of Obstetrics and Gynecology, Medical University of Graz,Auenbruggerplatz, A-8036 Graz, Austria. Tel: +4331638581082; Fax: +4331638512546; Email: edgar.petru@medunigraz.at
Received Date: 26June,2017; Accepted Date: 10July, 2017;
Published Date: 17 July, 2017
Citation: PetruE (2017) Sequential Response of a Platinum-Sensitive Ovarian Cancer Recurrence to Olaparib after Previous Response to Niraparib - A Case Report. J Oncol Res Ther: JONT-125. DOI: 10.29011/2574-710X.000025
1. Background
PARP (Poly(ADP) RibosePolymerase)-inhibitors have recently been introduced in the treatment of patients with recurrent platinum-sensitive ovarian cancer and a BRCA-mutation. Niraparib resulted in a significantly prolonged Progression-Free Survival (PFS) in both BRCA-wild type as well as BRCA-mutated ovarian cancer recurrence in the ENGOT-OV16/NOVA Studie [1].Similarly, olaparib revealed a significant PFS benefit inBRCA-mutated patients (Study 19[2], SOLO2-Studie). The clinical course of a patient who received successfully subsequent treatmentwith the two PARP-inhibitors is described.
2. Case Report
A 56 years-oldpatient with hereditary ovarian cancer and a BRCA2-mutationwas diagnosed with a FIGO stage IIIc high-grade serous ovarian cancer. Initially, she received3 cycles of a platinum-based chemotherapy.After interval-debulking with no residual disease she received three additional cycles of chemotherapy plus trebananib within the TRINOVA 3 study.Due to pleural tumor progression, platinum-based chemotherapy was started again. After a partial remission to second-line chemotherapy, the patient received the PARP-inhibitor niraparib fora total of eight months within the NOVA-study. A complete remission of the pleural effusion was stated.
Due to further tumor progression, Niraparib was discontinued. The patient now
received 6 cycles of carboplatin and gemcitabine. After achievement of a
partial remission following third line chemotherapy, treatment with the second
PARP-inhibitor olaparib was initiated.The latter agentwas administered orally
at 800 mg/Tag divided in two doses. The patient is currently alive and well
with no evidence of disease. Toxicity was minimal. No nausea, vomiting, or diarrhea
was observed (Table-1).
3. Conclusion
Targeted therapy with PARP-inhibitors in patients with BRCA-mutated ovarian
cancerrepresents a relatively new therapeutic option.Our patient is now in
complete remission 4.5 years after primary diagnosis of an advanced high-grade
serous ovarian cancer deveoping its first recurrence as early as 15 months
after primary diagnosis. After severalplatinum-based chemotherapies including angiogenesis
inhibitors and treatment with two different PARP-inhibitors the patient is now
still in remission. This case illustrated that there may exist no
cross-resistance between niraparib and olaparib.
|
Date
|
Diagnosis/Event |
Important Therapeutic Steps |
|
Oct-12 |
Serous high-grade FIGO stage IIIc ovarian cancer |
Explorative laparotomy |
|
10/2012-12/2012 |
Neoadjuvant chemotherapy |
3x Carboplatin + Paclitaxel + 1x Trebananib (angiogenesis inhibitor) |
|
Jan-13 |
Interval-debulking surgery (no residual diseases) |
Total abdominal hysterectomy, bilateral salpingo-oophorectomy hysterectomy, sigmoid resection, omentectomy, splenectomy, pelvic and paraaortic lymphadenectomy |
|
2/2013-4/2013 |
Adjuvant chemotherapy + trebananib |
Additional three cycles |
|
5/2013-12/2013 |
Consolidation therapy |
Trebananib |
|
Dec-13 |
Development of bilateral glaucoma |
Probable association with study medication. End of study treatment |
|
Mar-14 |
Cytologically verified bilateral pleural effusion (right 6 cm, left 1.8 cm) |
Karnofsky 80 |
|
3/2014-7/2014 |
Partial remission |
6x Carboplatin/PEG liposomal doxorubicin |
|
9/2014-7/2015 |
Left pleural effusion and lung metastasis 1.3 cm |
Niraparib study medication (NOVA study): Partial remission |
|
7/2015-9/2015 |
Progression of left pleural effusion + peritoneal carcinomatosis |
3 cycles of carboplatin and gemcitabine |
|
Sep-15 |
Carboplatin hypersensitivity reaction at cycle 3 |
Stop of carboplatin therapy |
|
9/2015-12/2015 |
Change to 3 cycles of oxaliplatin monotherapy |
|
|
Dec-15 |
Partial remission of peritoneal carcinomatosis |
Start with olaparib therapy |
|
12/2015 ongoing (6/2017) |
Continuous therapy with olaparib |
Maximum toxicity: Grade 1 anemia, grade 1 peripheral sensory neuropathy |
|
Jun-17 |
Radiologically, biochemically and clinically no evidence of disease |
Karnofsky score 90 |
Table 1: Overview of the clinical course of disease in the 56 years-old patient with FIGO IIIc recurrent ovarian cancer.